International Health service Corps (IHSC)

I came across an interesting article in New England Journal of Medicine September 2010 issue. “An International Service Corps for Health —An Unconventional Prescription for Diplomacy” by Vanessa Bradford Kerry, M.D., Sara Auld, M.D., and Paul Farmer, M.D., Ph.D.

We are all aware of Peace Corps. Dr. Bradford Et al proposed a concept of developing a program based on providing health care assistance to international community. This could benefit various countries. In almost all disasters United States is one of the leading countries to provide major contributions to affected countries.  If we have this in place, it would make a better and more effective way to combat major illness and disasters.  

Articles states,

“To break the cycle of poverty and disease, we believe that the United States should create the equivalent of a Marshal plan for health. A program that would train and fund both local providers and US health care professional to work, teach, learn and enhance the health care workforce and infrastructure in low income countries. We envision this program as an International Health service Corps (IHSC)”.

It also elaborates that one third of the world population survives on less than $2 a day; there is a loss of 4.6 million lives annually from AIDS and TB alone, along with deaths of 6 million children who die before the age of 6 from preventable diseases.

IHSC could have collaboration with other countries, any where there is a disaster, like the Haiti earthquake, we can contribute in a quicker and more effective way.

Physicians and nurses could be provided with incentives including loan forgiveness and scholarships, which could make this program more appealing.

In short I think this is a great prospective and has a great potential.

About the picture: I used a 70/300 Nikon lens to take this shot just after sunset.

Predator.

You can not judge a book by its cover, nor can you be always correct about first impressions. You are also expected not to judge a person. You are also taught to give a second chance. This is all true but we are humans after all and we all are guilty of doing everything opposite of what I just said. The argument would be that the intrinsic potential of a person never changes, an eagle would always be an eagle and a vulture would be a vulture. Can you change the true nature of a person?

I often see inmates at the hospital who are brought to us for various problems. I have seen some who have swallowed blades so they can get out of jail for few days to people who have sliced their hands with broken door handles. You deal with them just like you deal with any other patients as per Hippocratic Oath. Along the same lines I always try not to find out what brought them to the slammer in the first place.

Few years ago I saw inmate in the hospital. He was shackled to the bed with two guards around him. He had an ovoid face, wrinkled skin far beyond his age. He had gentle and deep eyes; he was taller than most and touching mid sixties. He was dressed in not so ever modest hospital gown. Ironically his handcuffs and ankle restraints appeared to be brand new.  I found him civil and pleasant to talk to. He appeared to be well versed and informed about his condition. I got a sense he must be a college graduate the way he was able to formulate his thoughts with the use of  proper lingo.

I saw him for couple of days before I was informed by a staff that he was incarcerated after being found guilty of raping a 6 or 7 year old and then choking her to death. The girl was a kin!

Being a father of 2 girls; it is difficult to isolate your emotions in these situations. I saw him the next day with a straight face. I asked my patent question “Sir is there any thing else I can do for you?” I discharged him in the next few days.

I have a vivid memory that just before discharge he complained to me about neck pain, it was an effort for me not to ask him “Sir, do you think your pain is more than the girl you choked, is it more than what she must have endured at the last few seconds of her life”.

I have always believed that nothing is absolutely bad nor anything is absolutely good. This incident is one of the times when I questioned my philosophy. What do you think?

About the Picture: I took this shot of Tyrannosaurus rex, largest land predator of all times at Field Museum, Chicago, however, man maybe the worst.

Alien Factor and United Nations.

I saw a post today by a friend of mine, Abbas who resides at the border of Italy and Austria. Pretty far away from here. But the post was about things which are much farther than earthly distances. It is about new frontiers, where no man has ever gone before.

Today is a historical day; united nations have appointed a first contact for any aliens who may decide to drop by. A Malaysian astrophysicist Ms. Ottman has been nominated to perform this job. She recently stated “The continued search for extraterrestrial communication, by several entities, sustains the hope that some day humankind will receive signals from extraterrestrials”. She further states "When we do [make contact], we should have in place a coordinated response that takes into account all the sensitivities related to the subject. The UN is a ready-made mechanism for such coordination.” Ms. Othman is currently head of the UN’s little known Office for Outer Space Affairs (UNOOSA).

Wow I like this UNOOSA’s “beam me up Scoty” job. But I do have some questions. How do you qualify for this job. As you may have guessed by now I am not an astrophysicist but I have been a Trekkie all my life along with my big brother (Yes I confess). So I wonder first and foremost how do you get this job. Do you need past experience of alien abduction or dealing with aliens, if you do, how you can prove it. Second what is the tenure for this job, do you get fired if you have no alien contact in the first 10 years of your job.  Third, how is your job performance measured? Talk about job insecurity.

Well all jokes aside this is forward thinking. Prepare for everything. So power to Ms. Ottman.

I remember this intriguing quote from book Contact by Carl Sagan, when little Ellie inquires from her father about existence of life out there, he says “Well, if there wasn’t, it’d be an awful waste of space.”

So you must be wondering what this has to do with medicine. Nothing!

About the Picture: Getting ready for a job interview.

Have a Seat Please.

Physicians who sit down during a hospital patient visit are perceived as spending more time with patients versus who stand.  A study conducted at University of Kansas concluded these results after reviewing data from 120 visits.

Physicians who took a seat were thought to spend five minutes with the patients; where there actual time was just over a minute. Physicians who stand up during the visit spent 1 minute and 28 seconds and they were perceived as spending 3 minute and 44 seconds.  Doctors who sat down were believed to be spending 40% more time with patients than standing up.

So next time have a seat.

About the Picture: Some street artist caught my attention. Specially the one on the right. It is exhausting work. Cough up some money next time please, will ya!

Kaizen

I was invited to be a content advisor for a Kaizen training program. Toyota production system is known for following Kaizen. It refers to a system which constantly works to improve various processes; this could be implied to business, production lines or health care. Training involves all employees from CEO to security. Organizations like NASA to hospitals are using the core philosophy of Kaizen and lean principles. I was able to attend some of it but what I heard and what I have read in the past was most interesting.

Kaizen demonstrates a strong desire to eliminate Muda, a Japanese word for wasteful or non value activity. If you look at the way we do work, there is a lot of duplication in what we do. From my perspective nurses ask all the same questions to the patient as we do. Past medical history of a patient is not updated in medical records. We invent the wheel all over again when we admit an old patient.  There is a lot of Muda from where I see it.

This whole week I have been seeing people running in black vest, working on small projects other than their usual duties. One of the ideas one staff member came up was to implement a color coded patient census board. Like red denoted 100 % census and yellow 75%. This helps with early discharges and other planning involved.

The five main principle of Kaizen are

§                     Teamwork

§                     Personal discipline

§                     Improved morale

§                     Quality circles

§                     Suggestions for improvement

.

Kaizen Way, a book by Robert Maurer deals with applying Kaizen principles on a more personal level. You may find it an interesting read.

About the Picture: Port Canaveral, Florida.

Pain Clinics and Chill Pill Mills.

Recently I attended a presentation by an Interventional Pain management physician, Dr Maulik B. Some of the facts that he stated were mind blowing.  I also read this article in Time magazine.

Some of the facts are stated below.

• In Broward County, Florida there more pain clinics than burger joints. There are 115 pain clinics in the county versus 70 burger franchises.
• 18 out of the top 25 Oxycodone prescribing doctors are in Broward county.
• Deaths related to prescription drug use rose from 2,780 in 2006 to 3,750 in 2008.
• Pain Clinics can be run by doctors who are not citified in pain management.

I personally have seen patients being prescribed 360 tablets of Oxycontin along with Valium and Soma. The street value of 10-20 mg of Oxycontin is 70-80 dollars. Just imagine if someone is prescribed 100 tablets of Oxycontin, that is straight $7000.

People are driving all the way from Tennessee to make a quick buck. When I initially moved to Florida, I remember that there was a clinic which was busted after authorities noticed that they had a sign outside that said “We prescribe Vicodin and Percocet”

I admit patients everyday with excess prescriptions for narcotics. I remember a case when I admitted a 21 year old young man with respiratory failure after a narcotic overdose. He was later placed on life support after being diagnosed with anoxic brain injury. His girlfriend used to visit him with their cute 2 year old girl. I used to feel bad about this little girl that she will miss out on her father. He died and 8 months later I admitted the girlfriend with similar presentation. She also died in the next few weeks. That little girl must be very lonely tonight.

So my friends this is the human factor in medicine and life.

About the picture: Happy M & M seen in New York.

Medicare Cost and Million Gazillion Dollars.

Recent new estimates from US government reported a 17.3% increase in health care spending as compared to the previous year. This is the largest jump in half a century. 2.5 trillion spent on healthcare was 134 billion more than last year. These are very huge numbers, beyond my comprehension. The way I see it they will continue to grow.

How we contribute to this cost, is best explained in the words of a patient I recently admitted.

ER called me regarding a patient who was unresponsive. She was in her late eighties. Patient had a comprehensive work up including labs, chest x-ray, EKG, cardiac enzymes and CT of the brain. These entire series of tests were predominantly negative.

When I saw her on the floor she struck me as all gray, her hair was all gray, skin ashen and face pale; like a flower dying slowly. She was still not responding to any commands, I saw that there was an order for a MRI of the brain and carotid ultrasound. After examining her I reviewed the records in the chart from the nursing home and among other things there was a DNR (Do Not Resuscitate) order in the chart.

I called the son and he asked me, what his mother was doing in the hospital. I told him about her grim status. He informed me that she was always good to him, he was her favorite.  She had started to deteriorate once dementia started to set it.   Now she had been non verbal for a year. She was like an empty shell. He decided to enroll her in hospice a year ago. I assured him that I will call hospice. Within few hours hospice saw the patient, I cancelled all pending labs and test and she was transferred to nursing home with hospice. 

Hospice patients just want to be comfortable, they do not want any heroic measures or any further diagnostic test. Even within twelve hours of her stay in the hospital, Medicare will be billed probably more then 15 grand, excluding bills from EMS etc. All of this could have been saved if someone had paid more attention to her code status at the nursing home, ER or on the floor.

The sad part is not just the cost of care but taking the opportunity away from some loved one to die in peace rather than dying with tubes coming in and out of you.

About the picture: I shot this at my backyard.

White Board R’ Us. Part II.

This blog is a continuation of a previous posting “White Board R’ Us”. I wrote earlier regarding utilization of white boards in patient’s room.  It is a very simple and one of the most effective tools to improve communication. This is based on a study conducted by Dr Sehgal at University of California.

It has been over a month since I have been using this medium to convey the plan of care to the patient. I just use simple layman language. It starts with my name, date, their diagnosis and plan for a particular day.

So like for the patient above, I jotted down on the board that he will be getting steroids for a rash, antibiotics for a skin infection and an ultrasound to check for a clot in his arm.

Patients seem to be more informed about their diagnosis and plan. They are more appreciative and they know what is coming to them later in the day.  I usually do not use the white board if the patient is confused or being discharged home.

I will keep you posted as this is work in progress.

Viagra (Niagara) Falls.

Sleep, the final frontier where few doctors have gone before.

As a physician you learn to compromise on a good night sleep.  While on-call you get phone calls of various nature at all odd hours of the night. Just recently I received 24 pages from 11 pm till 7 am. So you can imagine the quality of sleep one gets.

Every doctor has a plethora of stories regarding the calls we receive during a given day or  night. Ninety percent of these calls are appropriate and the rest, I better not say any thing. I will give you samples of few remarkable calls I have received during nights in the last few years.

·         4 AM, call from a nurse, “Doc, I just want to inform you that patient has dark urine”, I inquired “you mean patient has blood in urine”. Nurse, “No, It is just dark yellow in color”. I replied, “Please keep a very close eye on it, if it turns blue let me know”.

·         5 AM, last month from a nurse, “We just want to tell you that patient is allergic to Diovan and he is on Labetalol”. I asked, “Is he on Diovan?”. Response, “No”. I was speechless and sleepless after that.

·         2 AM a nurse from ICU: “I just want to inform you that patient has a critical BUN level of 3”. My response, “STAT transfuse 2 units of BUN”.

·         5 AM during residency: Code beeper goes off: I ran to the patient’s room. Code team was at bedside. I touched the patient, he is cold and stiff but I was still asked to run a code. Of course I refused for obvious reasons; rigor mortis never responsive to resuscitation.

·         I was called during my first year of training by nurse around 3 AM for medication for headache. I gave her the quick orders while in an attempt to catch a quick 2-3 hours sleep before going back to the ICU rotation. In the morning the same nurse told me that she did not give the medication I ordered. She told me that she heard me say, give 1 tablet of Viagra. She was unsure so she called the pharmacy to find out if there were any indication for Viagra for headache, they told her that there were none. She gave the patient Tylenol instead and notified me in the morning.

I strongly believe that in a hospital setting a dedicated nocturnist, can improve safety and decrease errors related to “burn” effect.

About the picture: While walking in New York.

CPOE vs. CAPTCHA vs. Diabetes.

You must be wondering what is CAPTCHA? This is an acronym which stands for “Completely Automated Public Turing test to tell Computers and Humans Apart". This is a combination of different letterers and numbers you see at websites for security and prevents spam.

Regardless of how fail-safe our security is; you will always need a human interface. Or maybe it is my intrinsic desire to be superior to computers.

I have been a strong supporter of CPOE (Computerized Physician Order Entry) as you may have read it in my previous post “I Stole A Cow”. Recently I came across a Leapfrog study. Leapfrog group partakes in reducing medical mistakes and try to improve quality of care. There has been several studies in the past regarding safety and reduction of medication errors. However, a recent study conducted at 214 hospitals using a simulation tool missed one half of non fatal appropriate warnings and missed one third of fatal  order errors. Now this is something to think about.

I was attending a physician staff meeting last night. The speaker pointed out how there is a degradation of clinical protocols with time as new data emerges every year. One prime example is Leuvin Belgium study regarding Intensive Insulin therapy for hyperglycemia. We all jumped and started to mimic these results. However, later we realized that intensive glucose control can lead to increase mortality as shown by NICE-SUGAR and VISEP protocols. Since then we have changed our target numbers for normoglycemia.

My point is, that though we see a significant benefit from utilizing all new protocols, devices and systems. But we should not loose our skepticism. In my heart I am a skeptic, not so much to ask God for an ID card but enough. I believe in this analogy that if one person calls you an ass, don’t worry about it, if two call you an ass, step back and think about it. If three does, get rid of the tail!

Tattoos.

Teenage is considered to be an age of chaos. You are exposed to various elements, it is an era of change, raging hormones and you are invincible. A friend of mine recently said when your child is a toddler, they are so cute you want to eat them and when they are teenagers you regret why you did not.

Henna (Temporary tattoos) is considered to be a symbol of celebration in eastern cultures. At wedding, girls get together and get very complex intertwined design on their hands and feet.

It was refreshing to see a young teenager Raza the other day. This kid turned Henna into a symbol of joy and utilized this medium to benefit cancer survivors. He is a gifted boy with an artistic approach. He has started offering these design to girls of different ages, and the funds he raises goes to Relay for life which is a volunteer-driven organization for cancer survivors.

Raza could be reached through this facebook account.

About the picture: Henna by Raza, picture over my guitar.

Time.

Someone inquired the other day, how do I find time to write these blogs. I pondered for a moment and quoted John Maxwell “Each human being has exactly the same number of hours and minutes every day.”  We have no more or less time than George Washington or Gandhi. Money can not buy you time nor can you borrow it from anyone. You have to make time Period.

Of course I am not in the same league as these great people, but I try to utilize my time the best way I know. Now suffering from chronic insomnia has its advantages and disadvantages. For the most part I survive with 5 hours of sleep.  Anything less makes me cranky.

Isn’t it funny when some friend calls you after a long time. Usually their excuse for not calling sooner is that have been very busy. But after a while when you ask them what they have been up to; their response usually is “nothing much, same ole’ boring life.”  So much for being busy!

Time is relative. Not as in the theory of relativity, but as how we see time. We have a very sharp perception of time when we are at home or at work, everything in our surrounding reminds us of time passing by. You are subconsciously aware of time as events happen at certain intervals. You know it is 7 AM because this is the time you go to work, few minutes elapses before the coffee  brews, lunch happens at 12 pm, meetings at 3 pm, going back home at a certain time, you exercise for an hour and an hour worth of TV program in the evening etc. etc. However, if you are outside on a beach or in the wilderness our perception is very poor. With no distractions or constant reminders times passes at an exceptionally slow rate. There are no milestones to remind us of the passage of time, maybe just the sun going up and down.  

The same thing happens when you are healthy and have no ailments. We experience no reminders of sands of time as long as we are healthy. No back pain after waking up, no prostate problems and no heart attacks. But with age nature starts to call on you with subtle reminders. You start experiencing more headaches, ankle pain, menopause and the list goes on.

Again these are subtle reminders, on the other hand people who suffer from terminal illnesses do not have reminders; they have alerts at the last moment. I have known patients who have asked me this question, do they have another month to live. Just imagine that a person has made peace with themselves that they will not see November 1^st, but they want to live till October 15^th. They can cram their whole life in one month. You can learn the value of time from them. They do not want to waste any time as they are acutely aware of the time wasting them.

Well I had a day off today so I had a lot to think about. I spent a whole afternoon at the library most of the time reading Kissinger by Walter Isaacson;  that was not a waste of time.

About the picture: Allegedly the biggest clock there is, but it was out of order that cloudy day. 

Wrong Diagnosis.

“I choose to begin with I am wrong because it is the hardest of the phrases to say and genuinely mean”. Richard DeVos starts his book Ten Powerful Phrases this way.  

I was reading this book today; he narrates some of his life experiences and lessons that he has learnt. The  phrase “I am wrong” is simple to write but difficult to say. To admit when you are truly mistaken is equally difficult.

I took care of a patient recently. He presented with right upper quadrant pain. His liver function panel was slightly abnormal but his pancreatic enzymes were quite erratic. I obtained a CT scan of the abdomen and a HIDA scan. Considering the clinical picture I was quite confident that this patient has pancreatitis due to gallstones, without common bile duct obstruction.

One of our gastroenterologist and a surgeon were on the case. The GI suggested an ERCP (study to evaluate pancreas and billiary duct), I was confident that ERCP was not needed and urged the surgeon to proceed with laproscopic removal of gall bladder.

During the surgery when surgeon performed a cholanagiogram she realized that there is indeed an obstruction of the billiary duct. Patient ultimately had to go through an ERCP the next day.

I saw the GI doctor the other day, initially I almost considered saying that it could have gone either way but instead I said “I was wrong!”. It takes an effort to accept you are mistaken.

On the other hand it is better to know when you are wrong rather than being wrong and not knowing about it.   

About the picture: I entered my room one day and found my daughters trying on my jackets.

Simplify.

I recently came across an article Simplifying your life from a fellow blogger Doctor John Halamka, Chief Information Officer at BIDMC. 

Unfortunately simplifying it self is a complex procedure. You would require a paradigm shift and shed some of the load we carry. As we grow old our culture promotes complexity. At least this article provides us with something to ponder.

It is very inspirational and I have already shared it with few friends of mine. Please take a look at this article and tell me what you think. 

About the picture: Picture taken at Chicago Art Museum.

9/11 Nine Eleven, 8:45 AM. A Minute Before Impact.

“I remember looking at their faces when they walked in the church…… their faces were so blank almost like a deadened look on their faces. But after a while they talk, and eat, and sit and you’d see them leave smiling”.

Tara Bane

Victim’s wife and volunteer.

 Sometimes I wonder what do we have to show for. Is it really all about getting a good education or making few more bucks or collecting some more "stuff" in your life. 


What is our contribution?  Have we made a difference in someone's life.... if we have than I hope in a good way.  Let''s start small, let us make a change in just one life. 
Let's talk .....

I wish at 8:45 AM, someone could have talked to them.

About the picture: Badges of workers and volunteers at ground zero on my last trip to New York.

Victim. Where is the SVU?

It was almost five years ago, when I saw her. I do not think she was white but kind of whitish! She had a little bit of Native American in her. She was in her thirties, taller than usual and one of those quiet type. She always wore a pony tail and had freckles on her face, and she had an infectious laugh which gave her an innocent look. She was jittery and very anxious, biting her nails all the time. She had two children but I can not recall if those were boys or girls.

There was something about her. She always looked scared, like she was watching her back. She was reluctant to be examined when I saw her first. Every time I would examine her she would cringe. I remember telling my wife years later that she looked so scared and anxious that I should have explored the reason behind it a little more closely.

I saw her most of the times for minor ailments like headaches or joint pains. Then I started to notice bruises which she could not explain. She had a big jagged scar on her belly which she explained was from a previous surgery.

One day she came to me with multiple bruises. I was suspicious and asked her bluntly what was going on. She was hesitant initially but finally gave up and started to talk frankly. She came from a family where she was abused as a child. She was divorced; she had no place to stay so she was still living with her ex in-laws. Her ex-husband was physically abusive and whenever he would swing by his parent’s he would have his way. One time he punched her so hard that it caused perforation of her bowels. Just imagine the brute force required to hit someone so hard, that it would burst someone innards. Envisage the desperation and sacrifice on her part to continue to live in this situation so that her kids could have a roof over their heads. She fit the profile of a child who is abused; they have a higher chance to end up in a similar situation.

I was very upset hearing that, I advised her to call the authorities. I told her if she would not then I will. She refused and told me that even if I call them, she will never press charges. I advised her to go to one of the safe houses or shelters around Tampa. To my surprise when I called a couple of places around Tampa I was given a run around. I was so surprised that considering that we see all these ads about resources available to us in news and magazines, when you really need them you can not get them. Every place started with eligibility requirement which she did not qualify for. I even asked a supervisor how much beating would she need before we can get her in one of these safe places. They did not like it. I wonder where the SVU (Special victim units) are.

When she was leaving she was smiling…. what was behind that smile I can only imagine. I never saw her after this episode. Sometimes I wonder what became of her. Her kids should be older now, I hope she is too.

About the picture: I stole this picture over the web. Woman displaced after the flood in Pakistan.

# 7 Life Is Good, #6 "Ciken" Wings.

This is a detailed account of what I mentioned in an earlier blog My Teachers.

Not so long ago after a busy and tiring day I came back home quite late. We usually sit down with our two daughters at dinner time and either do some fun activity or watch some TV together. Their favorite show is America's Funniest Video. Both my daughters 8 and 6 years old love that show. 

When you are a child you are easily amazed, unfortunately it takes more and more as you grow old. I think wonder never cease to exist,  however we loose the ability to appreciate it as time fogs our vision as we grow old. It is a precious gift to watch a child laugh for no reason at all. 

 So as we were watching the show, my 6 year old asked me, "Baba, can we make a funny video too". I asked her why. She said, "If we make a funny video maybe we can send it to America's Funniest Video". I assured her we can do it but why should we need to do that. She said, “If they like my video maybe we can win TEN THOUSAND DOLLARS" 

"Wow that is a lot of money, what are you going to do with it" I said. She thought for a moment and replied solemnly "I will give it to your hospital". I was surprised because I was thinking she will probably ask to buy some gifts or dolls. Still bewildered I asked her, "why would you do that?"

What she said next would stay with me for the rest of my life. She said ,“Then may be you can spend some more time with us". The decisions I made after that were pretty obvious.

"Nobody on his deathbed ever said, I wish I had spent more time at the office" Unknown.

About the picture: My daughter wrote this note about our family.

One Hero Every Day.

In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity. Cardiologist never steps on each other toes, radiologist call admitting doctors for any bizarre findings and hospitalist notify the primary about their patient’s update.  Physicians discuss their plan of care with nurses and nurses in turn make sure all support staff is conveying the same message to the patient. Nurses keep a direct contact with their assistants, physical therapist etc and they inform each other about any significant changes. And…… by now I usually wake up from sleep and face the nightmare of reality.

There is no “I” in a team. Unfortunately I often feel that there is a desire from everyone to work as a team however adjective never transforms into a verb. We all work in our little domains, administrators do their own thing, physicians after seeing a patient do not see the big picture and nurses immerse themselves more in entering data rather than reviewing what data means.   

In every hospital I have worked at, there is a huge void between physicians and administrators. I often feel a free flow of information and mutual trust can reach goals better than “need to know” policy.

Half of the physicians do not get along with each other. There is constant bickering about stealing patients and how unethical the other doctor is. Please do not take me wrong I have my moments of bickering too but I try not to. If a primary decides to use another physician to admit a patient other than our group, I try to self evaluate ourselves and see why did this happen, were we doing something wrong or was it a purely business decision from primary care. And if it is, then it is a free country, I believe in free will and enterprise.

I call this overall behavior “Maximum of Minimum attitude” where you do the minimum best among our own domains and seldom cross over. I think we need to put more emphasis on team work. Workshops among all hospital based personals should be encouraged.  We need to emphasize on the bigger picture rather than our cocoons.

There need to be one hero everyday rather than one hero all the time. 

Blog you later.

About the picture:  Memorial altar at St. Paul Church at Ground Zero .

How Do You Like Them Yankees!

This happened few years ago at another hospitals I used to work at.

There was this emergency room physician who was doing the graveyard shift. It was late at night when he went to the physician lounge to catch the last few minutes of Yankees game. In the lounge he saw two technician working on a 52” Plasma TV. Apparently they were having problems with mounting it right.

Being a nice guy, he helped those guys to take the TV off the wall and move it to the next room and went back to the ER. Those guys were very appreciative and thanked him.

In the morning the staff could not find the TV in the physician lounge. When they reviewed the video they saw the physicians helping the two “technicians” who later loaded this TV in their van and made a quick getaway. Our doctor friend of course was not very happy.

So what lesson did we learn today? Is it a) Do not help strangers. b) Call Security when in doubt! c) Stay away from free food at physician lounge.

The answer is none of the above. It is…...Why watch a Yankee game when you can watch a good Red Sox game.

About the picture: Red Sox and Rays game at Fenway captured by my IPhone.

Message In A Bottle

Somebody asked me today “why a blog?” I countered “why not”. He said “what if no one reads it”. I replied “so what, think of my musing as a message in a bottle, I almost have no expectations that anyone would ever find it, probably it will be lost in the sea. It may also smash against a rock or maybe it would land somewhere on a castaway island never to be found. But if I won’t float the bottle, it will never reach its destination”. He got irritated and walked away.

I assured my self that at times people do find it; it can not be a total waste of time. People do find tales of joy or maybe tragic moments, sometime maybe a nudge to move on or perhaps someone’s life narration. They may learn to avoid the same mistakes the other person made or discover about things they can relate to. On the other hand if nothing is done then sum of zero is …….

Finally I moved away from the front of the mirror and walked away too……

About The Picture: Lake around my house.

Medicare Cuts And My Plumber.

So there was a neurosurgeon who called a plumber for a house visit. The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said “Even I don’t charge this much after a surgery”. The plumber stood up, gave him a sly look and said,” well that is why I am a plumber now; I used to be a neurosurgeon”.

I mention this as I was talking to a cardiologist few days ago. He said we are one of the few professions where someone else comes in and informs you how much you will get paid, regardless of what you do. Next time when you have a plumber at your house. try telling him what you want to pay him but do not hold your breath. Unfortunately every year with Medicare cuts we are seeing more and more doctors changing the way they run their practices.

Now we can argue that physicians are still compensated well, but on the other hand they also do a phenomenal job in helping and saving lives. A bureaucrat sitting in his office can decide how much health care institutes and providers will be compensated. However, these bureaucrats do not get up in the middle of the night or drive 80 miles an hour to reach the hospital to save a life. Neither do they have to reach the hospital within 90 minutes because the sooner they perform the procedure, better the outcome. Nor do they perform a cardiac catheterization which literally saves lives. However one thing they will never be able to share, is the sweet feeling of contentment about making a difference in someone’s life. By the way this doctor after spending three hours will get a profligate check of $253.

A plumber was actually at my house this week. He charged me $50 for consultation and $260 for fixing a leak. He was out within an hour. On his way out I did ask him, “Hey were you a neurosurgeon before?”

About the picture: A billboard at 43rd and 7th, NY.

My Teachers.

I have been blessed with great teachers. They showed me horizons which I thought did not exist. They had an array of personalities and professions. Not all of them were strictly in the academic settings. They varied in age and things they had to offer, at different stages of my life. Like my high school teacher Ms. S, who taught me time management and brought out the best in me. My father, who showed me being a doctor, is more than billing a patient.

My little 6 year old daughter, who taught me what is more important in life, when she asked me to donate money to the hospital I work at, I asked why. She said “so that you can spend more time with me”. My teacher at Beth Israel Hospital/Harvard Dr. Ferris Hall, who taught me that you can not ask for respect, you earn it.

My “singing heart” patient who taught me that you have the power to brighten someone’s day. My supervisor at the carpet cleaner company where I worked in Chicago during my first year in America, who taught never to treat anyone the way you don’t want to be treated.

Our janitor Julie, who spent decades at University of Massachusetts, taught me never to ignore people who help you, with what you do. She said "I feel invisible, people pass by me all day long but never seem to notice my presence". Indeed, she was right when I saw her next day working, she was….invisible to everyone.

I cannot forget my senior resident Kirk MacNaught, who told me once during my intern days when I was in a hurry to make a decision about a patient, “You should never treat a patient like you would not treat your own family member”. Then he continued in his soft voice “can you please stop running around the hospital like a chicken with its head cut off and get back to work”.  

I sometimes still run like that. I never claimed that I was the best pupil, I was just lucky to have great teachers. Most of all my patients are the best teachers, who teach me things I could have never learned in any school.


About the picture: I think this does not require any explanation.